Individual
LEILANI ANN PRATER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
23642 OLLIS ROAD, OLIVE BRANCH, IL 62969-0438
(573) 270-2694
Mailing address
PO BOX 438, 23642 OLLIS ROAD, OLIVE BRANCH, IL 62969-0438
(573) 270-2694
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
004928
MO
Other
Enumeration date
10/14/2013
Last updated
10/14/2013
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